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Hospitalization for the Initiation of Ketogenic Diet (CPB 0226, reviewed 2026-04-23)

Aetna·Pediatrics, Neurology, Critical Care +1 more·Medical Policy
Effective date
Apr 23, 2026
We identified it
Aug 18, 2026
Days to comply

Summary

Aetna has issued a new medical policy (CPB 0226, effective 2026-04-23) establishing coverage criteria for hospitalization to initiate ketogenic diet therapy. Coverage is limited to children under 18 with intractable seizures who have failed adequate anti-convulsant trials, plus patients with specific metabolic disorders (glucose transporter protein type 1 deficiency or pyruvate dehydrogenase complex deficiency). All other indications including adult epilepsy, autism, cancer, migraine, and psychiatric conditions are designated as unproven/experimental and not covered.

Action Required

Action needed
By April 23, 2026: (1) Billing team must update Aetna authorization and claims processing system to implement strict coverage criteria for ketogenic diet hospitalization—APPROVE only for pediatric patients (under 18) with intractable seizures who meet all selection criteria (failed adequate anti-convulsant trial ≥1 year, family compliance support, outpatient unsafe), and patients with glucose transporter protein type 1 deficiency (E88.09) or pyruvate dehydrogenase complex deficiency (E74.4). (2) Configure system to DENY claims for all other indications including adult epilepsy (G40.001, G40.011, G40.101, G40.111, G40.201, G40.211, G40.301, G40.311, G40.A01, G40.A11, G40.B01, G40.B11, G40.401, G40.411, G40.501, G40.801, G40.803, G40.821, G40.823, G40.901, G40.911), autism spectrum disorder, cancer, Alzheimer's disease, migraine, mood disorders, multiple sclerosis, Parkinson's disease, schizophrenia, spinal cord injury, Type 2 diabetes, and Prader-Willi syndrome weight management. (3) Create prior authorization template requiring documentation of: anti-convulsant medication trial history (specific drugs, dosages, duration ≥1 year, compliance), member age confirmation (must be <18), family/caregiver commitment statement, and explanation of why outpatient setting is unsafe. (4) Notify providers and medical directors of new restrictions. (5) Flag all historical ketogenic diet hospitalizations for adult patients and psychiatric indications for claim review/potential recovery. Failure to implement will result in inappropriate claim payments and compliance violations.

Affected Billing Codes

81000
81001
81002
81003
97802
97803
97804
A4250
A9152
A9153
S9470
E74.4
E88.09
G40.009
G40.019
G40.109
G40.119
G40.209
G40.219
G40.309
G40.319
G40.A09
G40.A19
G40.B09
G40.B19
G40.409
G40.419
G40.509
G40.802
G40.804
G40.822
G40.824
G40.909
G40.919
G40.811
G40.812
G40.813
G40.814